Communication Impairment and Dysphagia Following Acute Stroke: Prevalence, Co-occurrence, and Association with In-Hospital Mortality

Objective: To determine the prevalence, co-occurrence, and stroke-subtype distribution of communication impairment and dysphagia in acute stroke and their association with in-hospital mortality.Materials and Methods: In this retrospective, cross-sectional, single-center study, medical records of Turkish-speaking patients with confirmed acute stroke were reviewed. Within 72 hours of admission, a speech-language pathologist and the attending neurologist jointly classified communication impairment (aphasia, dysarthria, or both) as a binary variable, based on bedside observation, command following, and National Institutes of Health Stroke Scale (NIHSS) language/dysarthria items. Swallowing was screened with a validated bedside screening test.Results: Of 583 patients (mean age 66.3 years; 60.2% male; 92.8% ischemic), communication impairment was identified in 371 (63.6%) and dysphagia in 130 (22.3%). Both co-occurred in 111 (19.0%); 85.4% of dysphagic patients also had communication impairment. Dysphagia was more frequent in hemorrhagic stroke than ischemic stroke (35.7% vs. 21.3%; p=.048); communication impairment did not differ by subtype. Mortality (9.8%) was higher with communication impairment (crude OR=5.37) and dysphagia (crude OR=4.55; both p<.001). After adjustment for age, stroke severity, and stroke type, both remained independently associated with mortality (communication impairment adjusted OR=3.08, 95% CI 1.24–7.63; dysphagia adjusted OR=2.62, 95% CI 1.38–4.97).Conclusion: Communication impairment and dysphagia are common in acute stroke, frequently co-occur, and are each independently associated with in-hospital mortality. The communication impairment estimate warrants caution given its partial derivation from the NIHSS. Early assessment of both domains is critical for risk stratification and care planning.